Vidanapathirana Manudi Nushara, Palliyaguruge Thamalee, Wijewickrama Eranga
Professorial Medical Unit, National Hospital of Sri Lanka, Colombo, Sri Lanka.
University of Colombo, Sri Lanka.
SAGE Open Med Case Rep. 2023 Sep 14;11:2050313X231200966. doi: 10.1177/2050313X231200966. eCollection 2023.
Baclofen is a derivative of gamma amino butyric acid and is used for control of pain and muscular spasms. It is primarily excreted via the kidneys. In patients with impaired renal functions, the half-life of baclofen is prolonged and symptoms of toxicity can occur with normal doses. Commonly reported symptoms of baclofen toxicity are somnolence, altered mentation, seizures and respiratory depression. Myoclonus secondary to baclofen toxicity is scarcely reported. This case series describes two patients with chronic kidney disease (CKD) who were prescribed regular doses of baclofen for analgesia, and subsequently developed generalized myoclonus. The symptoms resolved with omission of baclofen and haemodialysis. There is currently no consensus on dose modification of baclofen in renal impairment for prevention of adverse neurological events. However, considering the surmounting evidence for low threshold of baclofen toxicity in CKD, dose adjustment protocols or consensus on contraindication need to be established.
巴氯芬是γ-氨基丁酸的衍生物，用于控制疼痛和肌肉痉挛。它主要通过肾脏排泄。在肾功能受损的患者中，巴氯芬的半衰期会延长，正常剂量也可能出现中毒症状。巴氯芬中毒常见的症状有嗜睡、精神状态改变、癫痫发作和呼吸抑制。继发于巴氯芬中毒的肌阵挛鲜有报道。本病例系列描述了两名慢性肾脏病（CKD）患者，他们因镇痛而常规服用巴氯芬，随后出现全身性肌阵挛。停用巴氯芬并进行血液透析后症状缓解。目前对于肾功能损害患者预防不良神经事件时巴氯芬的剂量调整尚无共识。然而，鉴于越来越多的证据表明CKD患者中巴氯芬中毒阈值较低，需要制定剂量调整方案或禁忌证共识。
